Vartiainen E, Nuutinen J
Department of Otolaryngology, University of Kuopio, Finland.
Int J Pediatr Otorhinolaryngol. 1992 Nov;24(3):201-8. doi: 10.1016/0165-5876(92)90017-j.
The study includes 54 cholesteatomatous ears in 50 children aged 16 years or less. The mean follow-up period after surgery was 7.1 years. In 26% of the ears the cholesteatoma was 'huge' involving the middle ear and the attic and filling the entire mastoid air cell system. A patient had lateral sinus thrombophlebitis. Patients with large cholesteatomas underwent canal wall down mastoidectomy with simultaneous tympanoplasty and, in most cases, cavity obliteration. Limited cholesteatomas were removed using either intact canal wall mastoidectomy or tympanotomy approach. Recurrence rate (including both residual and recurrent cholesteatomas) for the total series was 15% and 12% for the 50 cases undergoing one-stage surgery. Serviceable hearing (< or = 30 dB) was achieved in 57% of the ears. A reoperation was necessary in 26% and a third operation in 2%. At last follow-up examination, 94% of the ears had intact tympanic membranes but 4 patients (8%) suffered from cavity-related problems. Possible reasons for the disappointing results of surgical treatment for childhood cholesteatoma are discussed.
该研究纳入了50名16岁及以下儿童的54只胆脂瘤型耳朵。术后平均随访期为7.1年。26%的耳朵存在“巨大”胆脂瘤，累及中耳和上鼓室，并充满整个乳突气房系统。1例患者发生了外侧窦血栓性静脉炎。患有大型胆脂瘤的患者接受了开放式乳突根治术并同期行鼓室成形术，多数情况下还进行了术腔填塞。对于局限性胆脂瘤，采用完壁式乳突根治术或鼓室切开术进行切除。整个系列的复发率（包括残留和复发性胆脂瘤）为15%，接受一期手术的50例患者的复发率为12%。57%的耳朵获得了有效听力（≤30 dB）。26%的耳朵需要再次手术，2%的耳朵需要第三次手术。在最后一次随访检查时，94%的耳朵鼓膜完整，但4例患者（8%）存在与术腔相关的问题。文中讨论了儿童胆脂瘤手术治疗结果令人失望的可能原因。
